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Is This What Endemic Disease Looks Like?

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Is This What Endemic Disease Looks Like?

For months, some American and European leaders have foretold that the coronavirus pandemic would quickly develop into endemic. Covid-19 would resolve right into a illness that we be taught to dwell with. In line with a number of governors, it almost has.

However we’re nonetheless within the acute part of the pandemic, and what endemic Covid would possibly appear like stays a thriller. Endemic illnesses can take many kinds, and we have no idea but the place this two-year-old illness will fall amongst them.


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The coronavirus pandemic continues

International Covid-19 circumstances





40 circumstances

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per 100,000 per day

March 2020

W.H.O. declares

Covid-19 a pandemic

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40 circumstances

per 100,000 per day

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March 2020

W.H.O. declares Covid-19

a pandemic

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Source: Native governments; Middle for Methods Science and Engineering at Johns Hopkins College; Nationwide Well being Fee of the Folks’s Republic of China; World Well being Group

Word: Information as of April 5. Chart exhibits seven-day common.

At its most simple, an endemic illness is one with a continuing, predictable or anticipated presence. It’s a illness that persists. Past that, there is no such thing as a mounted definition.

Endemic illnesses infect hundreds of thousands of individuals around the globe annually, and a few endemic illnesses kill a whole bunch of hundreds. Some we are able to deal with and vaccinate in opposition to. But they’ll additionally trigger surprising outbreaks and vital struggling.

Interviews with two dozen scientists, public well being consultants and medical historians recommend the frenzy to recast Covid as endemic could also be lacking the purpose.

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“There’s been a political reframing of the thought of endemic as one thing that’s innocent or regular,” mentioned Lukas Engelmann, a historian of drugs and epidemiology on the College of Edinburgh. However epidemiologists use endemic to imply one thing we should always watch fastidiously, he mentioned, as a result of an endemic illness can develop into epidemic once more.

Endemic illnesses will be gentle or lethal

When folks consider endemic illness, they usually consider the widespread chilly. Higher respiratory infections, together with colds, are estimated to contaminate billions of individuals worldwide yearly however kill a number of thousand. Different endemic illnesses will be way more deadly. Malaria killed greater than 600,000 folks globally in 2019, and flu killed greater than 200,000, although estimates recommend these tolls may very well be a lot greater.


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Endemic illnesses should not with out struggling





New international circumstances per 100,000 in 2019

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New international deaths per 100,000 in 2019

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New international circumstances per 100,000 in 2019

New international deaths per 100,000 in 2019

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Many scientists predict that endemic Covid could have an identical burden to different respiratory viruses.

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“Will probably be no extra lethal than seasonal flu, or could also be gentle like one of many cold-causing coronaviruses,” mentioned Lone Simonsen, the director of the PandemiX Middle at Roskilde College in Denmark.

“The rationale for that is that we’ve plenty of immunity and we hold getting boosted from the infections that we run into,” she mentioned.

Some scientists warn that immune safety from vaccination and an infection could wane over time, and future variants would possibly sidestep these defenses. And mutations are random, so there’s all the time an opportunity a variant that causes extra extreme illness might come up sooner or later.

Endemic illnesses can have epidemic intervals

The widespread chilly and the flu are widespread endemic illnesses that persist yr spherical, however their ranges should not fixed. As an alternative they trigger seasonal epidemics, the place infections rise past baseline endemic ranges, usually within the winter when folks collect indoors.

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Influenza has seasonal epidemics

Share of examined specimens within the U.S. constructive for influenza Sort A





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2020

Covid-19

measures

disrupt unfold

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2020

Covid-19

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measures

disrupt

unfold

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These patterns are predictable, however folks can change them: The management measures used to blunt the Covid pandemic dampened flu and chilly waves in recent times, too.

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Scientists say that endemic Covid may very well be seasonal, nevertheless it might even have irregular and vital epidemic waves.

“Covid is far, way more transmissible than the flu,” mentioned Jeffrey Shaman, an infectious-disease modeler at Columbia College. “Solely a small portion of the inhabitants must be inclined for an outbreak to foment, and that may occur at any time of yr.”

The burden of endemic illness is unequal

One group’s expertise with endemic illness will be vastly completely different from one other’s, usually relying on who’s getting sick and whether or not they have entry to assessments, remedies and well being care.

H.I.V., which has continued throughout the globe for greater than 40 years, is one instance, although scientists and public well being employees use each “epidemic” and “endemic” to explain the virus.

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“One definition of endemic is outlined by geographic location,” mentioned Dr. Diane Havlir, an infectious illness specialist and professor of drugs on the College of California, San Francisco. “By way of that lens, H.I.V. is endemic in america, the place roughly 1.2 million individuals reside with H.I.V.”

“However H.I.V. is epidemic in subpopulations within the U.S.,” she added.


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H.I.V. disproportionately impacts sure teams

Estimated H.I.V. incidence in america by race and ethnicity





Adjustments in information methodology

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Adjustments in information methodology

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Infectious illnesses usually stay in communities the place poverty or discriminatory methods forestall entry to well being care, Dr. Havlir mentioned.

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“Illness disparities improve over time except they’re addressed on the outset,” she mentioned. “And that raises the query: Are we addressing these disparities with Covid or are we on that very same trajectory?”

With one-third of the worldwide inhabitants unvaccinated in opposition to Covid and life-saving remedies not obtainable to all, the virus’s burden will possible proceed to be unequal, consultants say, whilst components of the world resolve their ranges are endemic.

Endemic illness is all about management

Among the many many kinds endemic illness can take, one factor is obvious: Endemic doesn’t imply the tip of the illness.

As an alternative, it means dwelling with, and infrequently managing, a illness that has not been, or can’t be, stamped out. Well being consultants say that nations should use management measures, like testing, remedies and vaccinations, to maintain endemic illnesses in test.

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Nations with endemic malaria aspire to eradicate the mosquito-borne illness and depend on interventions like pesticides and preventative remedies to cut back its incidence. These management measures can drastically alter the course of endemic malaria, as they’ve in South Africa.


Malaria management packages can cut back illness transmission

New malaria case notifications in KwaZulu-Natal, South Africa


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2000 epidemic

D.D.T. use resumes

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2001

New therapy

launched

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2000 epidemic

D.D.T. use resumes

2001

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New therapy

launched

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Source: South Africa Nationwide Division of Well being, Barnes et al.

Along with environmental controls, vaccination packages can cut back circumstances and deaths. However when communities don’t adhere to vaccination suggestions, outbreaks can occur.

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Measles, for instance, remained endemic in america for 40 years after the introduction of vaccines. Throughout that interval, unvaccinated folks remained susceptible, fueling occasional outbreaks. In 2019, twenty years after the illness was declared eradicated in america, a number of outbreaks, many related to unvaccinated vacationers, contaminated greater than a thousand folks.


Outbreaks can occur even after a illness reaches endemic ranges

New measles circumstances reported within the U.S.


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1963

Measles vaccine

licensed in U.S.

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1989

Many measles

outbreaks

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2000

Measles declared

eradicated in U.S.

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1963

Measles vaccine

licensed in U.S.

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2000

Measles declared

eradicated in U.S.

1989

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Many measles

outbreaks

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Source: U.S. Nationwide Notifiable Illness Surveillance System by way of Mission Tycho

Word: Chart excludes circumstances reported within the Virgin Islands, American Samoa, Northern Mariana Islands, Puerto Rico and Guam.

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In contrast to malaria or measles, public well being consultants say that Covid can’t be eradicated, so management measures will assist decide the scale and course of future waves. (We’ve eradicated only one human illness: smallpox, which behaved fairly otherwise from Covid.)

Maintaining with Covid means staying centered on vaccinating, treating and updating vaccines, mentioned Dr. Monica Gandhi, an infectious illness specialist and professor of drugs on the College of California, San Francisco. “It’s going to take fixed vigilance to maintain it — to not eradicate it, which might be what people need — however to maintain it beneath management.”

When will we all know what Covid’s endemic part seems to be like?

In all probability not for some time. Scientists normally decide a illness’s endemic sample after observing it for a few years.

Pandemics can take years to settle, and the implications of widespread sickness can final lengthy after new infections fade.

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A lot of what we all know in regards to the transition out of pandemics comes from flu — people have witnessed 4 influenza pandemics within the final 100 years. The 1918-19 pandemic, which killed greater than 50 million folks globally, dwarfs all of them.


Pandemics take time to resolve and may return once more

Estimated influenza deaths within the U.S.


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1957–58

and 1968

pandemics

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Change in information methodology

Change in information methodology

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1957–58

and 1968

pandemics

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Change in information

methodology

Change in information

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methodology

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Source: Doshi 2011 (information previous to 2004); Facilities for Illness Management and Prevention (information after 2004); U.S. Census (inhabitants information for years after 2004).

Word: Information previous to 1930 used completely different prognosis standards that isn’t in step with later reporting strategies. Information after 2004 is proven as yearly values, whereas information from 2004 and earlier are month-to-month values.

It took the 1918 flu pandemic three years to settle right into a extra common sample, and america had a major 1920 wave that killed extra folks in some cities than earlier waves had. Within the years that adopted, some seasonal outbreaks have been bigger than others.

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The belief about Covid’s endemic interval is that it’ll look meaningfully completely different from the pandemic of the final two years. However endemic Covid, within the worst-case situation, might look one thing like the place we’ve been.

“You possibly can think about a scenario the place Omicron-like occasions occur yearly,” mentioned Trevor Bedford, a virologist on the Fred Hutchinson Most cancers Analysis Middle in Seattle.

“That may be the endemic state,” Dr. Bedford mentioned. “And it doesn’t imply that it’s gentle, and it doesn’t imply that it’s straightforward to take care of.”

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U.S. Efforts to Cut Emissions Stalled in 2024 as Power Demand Surged

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U.S. Efforts to Cut Emissions Stalled in 2024 as Power Demand Surged

America’s efforts to cut its climate change pollution stalled in 2024, with greenhouse gas emissions dropping just a fraction, 0.2 percent, compared to the year before, according to estimates published Thursday by the Rhodium Group, a research firm.

Despite continued rapid growth in solar and wind power, emissions levels stayed relatively flat last year because demand for electricity surged nationwide, which led to a spike in the amount of natural gas burned by power plants.

The fact that emissions didn’t decline much means the United States is even further off-track from hitting President Biden’s goal of slashing greenhouse gases 50 percent below 2005 levels by 2030. Scientists say all major economies would have to cut their emissions deeply this decade to keep global warming at relatively low levels.

Since 2005, United States emissions have fallen roughly 20 percent, a significant drop at a time when the economy has also expanded. But to meet its climate goals, U.S. emissions would need to decline nearly 10 times as fast each year as they’ve fallen over the past decade. That seems increasingly unlikely, experts say, especially since President-elect Donald J. Trump has promised to dismantle Mr. Biden’s climate policies and promote the production of fossil fuels, the burning of which generates greenhouse gases.

“On the one hand, it is notable that we’ve now seen two years in a row where the U.S. economy grew but emissions went down,” said Ben King, an associate director at the Rhodium Group. “But it’s far from enough to achieve our climate targets.”

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The biggest reason that U.S. emissions have fallen in recent years is that electric utilities have been retiring their older, dirtier coal-fired power plants and replacing them with cheaper and less-polluting natural gas, wind and solar power. That trend mostly continued last year, with a few unexpected ups and downs.

The nation’s demand for electricity, which has stayed more or less flat for two decades, suddenly jumped by roughly 3 percent in 2024, in large part because scorching heat during the summer caused many Americans to crank up their air-conditioners. A smaller factor was that tech companies have been building more energy-hungry data centers in states like Virginia and Texas.

While power companies installed large numbers of wind turbines, solar panels and batteries last year to meet rising demand, natural gas use also rose to record highs, while coal use declined only slightly. The net result was that emissions from the power sector increased an estimated 0.2 percent, according to the Rhodium Group.

At the same time, transportation, the nation’s largest source of greenhouse gases, saw an 0.8 percent rise in emissions last year. Gasoline and jet fuel consumption both increased as Americans continued to drive and fly more after the pandemic. Nearly 10 percent of new car sales in 2024 were less-polluting electric vehicles, but those models still make up a small fraction of total cars on the road and have yet to put a major dent in transportation emissions.

On the flip side, emissions from America’s industrial sector — which includes steel, cement and chemicals — fell by 1.8 percent in 2024. Some of that may have been the result of lost output, as two hurricanes and a strike at the nation’s ports disrupted some factory activity in the fall, Mr. King said.

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“It’s a reminder that there’s always some bumpiness in emissions,” Mr. King said. “It’s not just a question of how many electric vehicles are on the road or how much solar we’ve installed. A big portion of our economy still relies on fossil fuels.”

One of the most striking findings in this year’s data was that emissions from oil and gas operations dropped roughly 3.7 percent in 2024. Even though the United States produced record amounts of oil and near-record amounts of natural gas last year, many companies appear to have curbed leaks of methane, which is the main ingredient in natural gas and which can seep into the atmosphere and contribute significantly to global warming.

Over the past few years, the Biden administration and several states have adopted new regulations that require oil and gas producers to detect and fix methane leaks. Many companies also have financial incentives to capture methane to sell rather than vent it into the air.

Between 2014 and 2024, U.S. companies appear to have reduced the amount of methane that escaped, per each cubic feet of gas they produced, by 40 percent, according to the Rhodium Group.

Several experts have estimated that greenhouse gases generated in the United States could start dropping sharply in the years ahead if many clean energy policies stay in place, particularly the 2022 Inflation Reduction Act that pumped hundreds of billions of dollars into low-carbon energy technologies such as electric vehicles, wind turbines, solar panels, nuclear reactors, green hydrogen and batteries.

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While Mr. Trump has pledged to scrap many of Mr. Biden’s subsidies and tax credits for electric vehicles and low-carbon energy, it remains to be seen whether Congress will agree.

That law has not yet had a major impact on the country’s emissions, said Mr. King, since it takes time for new factories to open and power plants to get built. But, he said, data shows that low-carbon energy and transportation now make up fully 5 percent of total U.S. private investment.

“That’s a leading indicator that things are changing quickly,” he said.

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How to protect yourself from the smoke caused by L.A. wildfires

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How to protect yourself from the smoke caused by L.A. wildfires

You don’t have to live close to a wildfire to be affected by its smoke. With severe winds fanning the fires in and around Pacific Palisades, the Pasadena foothills and Simi Valley, huge swaths of the Southland are contending with dangerous air quality.

Wildfire smoke can irritate your eyes, nose, throat and lungs. The soot may contain all kinds of dangerous pollutants, including some that may cause cancer. The tiniest particles in smoke can travel deep into your lungs or even enter your bloodstream.

Conditions like these aren’t good for anyone, but they’re particularly bad for people in vulnerable groups, including children, those with asthma or other respiratory conditions, people with heart disease and those who are pregnant.

Here’s what you should know to keep yourself safe.

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Stay indoors

Minimize your exposure to unhealthy air by staying inside and keeping your doors and windows shut.

If you have a central heating and air conditioning system, you can keep your indoor air clean by turning it on and keeping it running. Make sure the fresh-air intake is closed so that you’re not drawing in outdoor air.

Keep your pets inside

They shouldn’t breathe the unhealthy air either.

Check your air filters

Clean filters work better than dirty ones, and high-efficiency filters work better than regular ones. The California Air Resources Board and the South Coast Air Quality Management District recommend filters with a MERV rating of 13 or higher.

You might consider using portable high-efficiency air cleaner in a room where you spend the most time. The U.S. Environmental Protection Agency has information about them here, and CARB has a list of certified cleaning devices here.

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Don’t pollute your indoor air

That means no burning candles or incense. If your power is out and you need to see in the dark, you’re much better off with a flashlight or headlamp.

If you’re cold, bundle up. This is not the time to start a cozy fire in the fireplace. Don’t use a gas stove or wood-fired appliances, since these will make your indoor air quality worse, not better, the AQMD says.

The CDC also advises against vacuuming, since it can stir up dust and release fine particles into the air.

Take care when cleaning up

You don’t want your skin to come into contact with wildfire ash. That means you should wear long sleeves, pants, gloves, socks and shoes. The AQMD even wants you to wear goggles.

If you’re sweeping up ash outdoors, get a hose and mist it with water first. That will keep it from flying up in the air as you move it around. Once the ash is wet, sweep it up gently with a broom or mop. Bag it up in a plastic bag and throw it away.

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It’s a good idea to wash your vehicles and outdoor toys if they’re covered in ash. Try not to send ashy water into storm drains. Direct the dirty water into ground areas instead, the AQMD advises.

Those with lung or heart problems should avoid clean-up activities.

Discard spoiled food…

If you lost power for a significant length of time, the food in your refrigerator or freezer may be spoiled.

Food kept in a fridge should stay safe for up to four hours if you’ve kept the door closed. If you’ve been without power for longer than that, you’ll need to toss all perishable items, including meat, poultry, fish, eggs, milk and cut fruits and vegetables. Anything with “an unusual smell, color, or texture” should be thrown out as well, according to the U.S. Centers for Disease and Control Prevention.

Refrigerated medicines should be OK unless the power was out for more than a day. Check the label to make sure.

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…even if it was in the freezer

Your freezer may be in better shape, especially if it’s well-stocked. Items in a full freezer may be safe for up to 48 hours if it’s been kept shut, and a half-full freezer may be OK for up to 24 hours. (The frozen items help keep each other cold, so the more the better.)

If items have remained below 40 degrees Fahrenheit (4 degrees Celsius) or you can still see ice crystals in them, they may be OK to use or refreeze, according to the federal government’s food safety website.

Ice cream and frozen yogurt should be thrown out if the power goes out for any amount of time. Meat, poultry, seafood, eggs, milk and most other dairy products need to go if they were exposed to temperatures above 40 degrees F for two hours or longer. The same goes for frozen meals, casseroles, soups, stews and cakes, pies and pastries with custard or cheese fillings.

Fruit and fruit juices that have started to thaw can be refrozen unless they’ve started to get moldy, slimy or smell like yeast. Vegetables and vegetable juices should be discarded if they’ve been above 40 degrees F for six hours or more, even if they look and smell fine.

Breakfast items like waffles and bagels can be refrozen, as can breads, rolls, muffins and other baked goods without custard fillings.

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Consider alternative shelter

If you’ve done everything you can but your eyes are still watering, you can’t stop coughing, or you just don’t feel well, seek alternative shelter where the air quality is better.

Hold off on vigorous exercise

Doing anything that would cause you to breathe in more deeply is a bad idea right now.

Mask up outdoors

If you need to be outside for an extended time, be sure to wear a high-quality mask. A surgical mask or cloth mask won’t cut it — health authorities agree that you should reach for an N95 or P-100 respirator with a tight seal.

Are young children at greater risk of wildfire smoke?

Very young children are especially vulnerable to the effects of wildfire smoke because their lungs are still rapidly developing. And because they breathe much faster than adults, they are taking in more toxic particulate matter relative to their tiny bodies, which can trigger inflammation, coughing and wheezing.

Any kind of air pollution can be dangerous to young children, but wildfire smoke is about 10 times as toxic for children compared to air pollution from burning fossil fuels, said Dr. Lisa Patel, clinical associate professor of pediatrics at Stanford Children’s Health. Young children with preexisting respiratory problems like asthma are at even greater risk.

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Patel advises parents to keep their young children indoors as much as possible, create a safe room in their home with an air purifier, and try to avoid using gas stoves to avoid polluting the indoor air.

Children over the age of 2 should also wear a well-fitting KN95 mask if they will be outdoors for a long period of time. Infants and toddlers younger than that don’t need to mask up because it can be a suffocation risk, Patel said.

What are the risks for pregnant people?

Pregnant people should also take extra precautions around wildfire smoke, which can cross the placenta and affect a developing fetus. Studies have found that exposure to wildfire smoke during pregnancy can increase the risk of premature birth and low birth weight. Researchers have also linked the toxic chemicals in smoke with maternal health complications including hypertension and preeclampsia.

What about other high-risk populations?

Certain chronic diseases including asthma, chronic obstructive pulmonary disease or other respiratory conditions can also make you particularly vulnerable to wildfire smoke. People with heart disease, diabetes and chronic kidney disease should take extra care to breathe clean air, the CDC says. The tiny particles in wildfire smoke can aggravate existing health problems, and may make heart attacks or strokes more likely, CARB warns.

Get ready for the next emergency

Living in Southern California means another wildfire is coming sooner or later. To prepare for the bad air, you can:

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  • Stock up on disposable respirators, like N95 or P-100s.
  • Have clean filters ready for your A/C system and change them out when things get smoky.
  • Know how to check the air quality where you live and work. The AQMD has an interactive map that’s updated hourly. Just type in an address and it will zoom in on the location. You can also sign up to get air quality alerts by email or on your smartphone.
  • Know where your fire extinguisher is and keep it handy.
  • If you have a heart or lung condition, keep at least five days’ worth of medication on hand.

Times staff writer Karen Garcia contributed to this report.

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Punk and Emo Fossils Are a Hot Topic in Paleontology

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Punk and Emo Fossils Are a Hot Topic in Paleontology

Mark Sutton, an Imperial College London paleontologist, is not a punk.

“I’m more of a folk and country person,” he said.

But when Dr. Sutton pieced together 3-D renderings of a tiny fossil mollusk, he was struck by the spikes that covered its wormlike body. “This is like a classic punk hairstyle, the way it’s sticking up,” he thought. He called the fossil “Punk.” Then he found a similar fossil with downward-tipped spines reminiscent of long, side-swept “emo” bangs. He nicknamed that specimen after the emotional alt-rock genre.

On Wednesday, Dr. Sutton and his colleagues published a paper in the journal Nature formally naming the creatures as the species Punk ferox and Emo vorticaudum. True to their names, these worm-mollusks are behind something of an upset (if not quite “anarchy in the U.K.”) over scientists’ understanding of the origins of one of the biggest groups of animals on Earth.

In terms of sheer number of species, mollusks are second only to arthropods (the group that contains insects, spiders and crustaceans). The better-known half of the mollusk family tree, conchiferans, contains animals like snails, clams and octopuses. “The other half is this weird and wacky group of spiny things,” Dr. Sutton said. Some animals in this branch, the aculiferans, resemble armored marine slugs, while others are “obscure, weird molluscan worms,” he said.

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Punk and Emo, the forerunners of today’s worm-mollusks, lived on the dark seafloor amid gardens of sponges, nearly 200 million years before the first dinosaurs emerged on land. Today, their ancient seafloor is a fossil site at the border between England and Wales.

The site is littered with rounded rocky nodules that “look a bit like potatoes,” Dr. Sutton said. “And then you crack them open, and some of them have got these fossils inside. But the thing is, they don’t really look like much at first.”

While the nodules can preserve an entire animal’s body in 3-D, the cross-section that becomes visible when a nodule is cracked open can be difficult to interpret “because you’re not seeing the full anatomy,” Dr. Sutton said.

Paleontologists can use CT scans to see parts of fossils still hidden in rock, essentially taking thousands of X-rays of the fossil and then stitching those X-ray slices together into one digital 3-D image. But in these nodules, the fossilized creatures and the rock surrounding them are too similar in density to be easily differentiated by X-rays. Instead, Dr. Sutton essentially recreated this process of slicing and imaging by hand.

“We grind away a slice at a time, take a photo, repeat at 20-micron intervals or so, and basically destroy but digitize the fossil as we go,” Dr. Sutton said. At the end of the process, the original fossil nodule is “a sad-looking pile of dust,” but the thousands of images, when painstakingly digitally combined, provide a remarkable picture of the fossil animal.

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Punk and Emo’s Hot Topic-worthy spikes set them apart from other fossils from the aculiferan branch of the mollusk family. “We don’t know much about aculiferans, and it’s unusual to find out we’ve suddenly got two,” Dr. Sutton said.

Stewart Edie, the curator of fossil bivalves at the Smithsonian National Museum of Natural History, said that Punk and Emo’s bizarre appearances shook up a long-held understanding of how mollusks evolved. Traditionally, scientists thought that the group of mollusks containing snails, clams and cephalopods “saw all of the evolutionary action,” said Dr. Edie, who was not involved with the new discovery. “And the other major group, the aculiferans, were considerably less adventurous.” But Punk and Emo “buck that trend,” he said.

The new alt-rock aculiferans reveal the hidden diversity of their group in the distant past and raise questions about why their descendants make up such a small part of the mollusk class today. “This is really giving us an almost unprecedented window into the sorts of things that were actually around when mollusks were getting going,” Dr. Sutton said. “It’s just this little weird, unexpected, really clear view of what was going on in the early history of one of the most important groups of animals.”

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